Key result
Carotid plaque imaging combining area and thickness improves CV event prediction over the PROCAM risk score.
Why the study?
Data were limited regarding the predictive value of atherosclerosis imaging beyond traditional risk calculators in younger subjects.
Does carotid plaque imaging improve cardiovascular risk prediction compared to the PROCAM risk equation in middle-aged subjects without known cardiovascular disease?
Cohort (n=2,508)
Does carotid plaque imaging improve cardiovascular risk prediction compared to the PROCAM risk equation in middle-aged subjects without known cardiovascular disease?
Absolute Event Rate: 0.9% vs 0.82%
p-value: p=0.001
Carotid plaque imaging significantly improves cardiovascular risk prediction beyond the traditional PROCAM risk equation in middle-aged subjects.
Should not yet change practice; leaves open prospective validation of plaque imaging for risk-guided therapy.
BACKGROUND: There are only few data about the predictive value of atherosclerosis imaging beyond traditional risk calculators in younger subjects. METHODS: We assessed cardiovascular risk prediction with the PROCAM (the Prospective Cardiovascular Munster Study) risk equation and with carotid plaque imaging (determination of total plaque area (TPA) and the maximum plaque thickness with ultrasound) in subjects without known cardiovascular diseases. The follow-up was generated during follow-up examinations as part of preventive medical examinations or by telephone calls. RESULTS: In 2,508 subjects aged 35 - 64 years (50 ± 8 years, 34% women), 132 (5.3%) cardiovascular events occurred (42 myocardial infarction, 17 bypass surgery, 31 stent implantation, 42 coronary artery disease defined by invasive angiography) during a mean follow-up period of 5.4 (1 - 12) years. TPA in combination with the maximum plaque thickness (type III - IV b plaques ) tended to be superior compared to TPA, and both plaque imaging methods were superior to PROCAM: area under the curve (AUC) 0.9 (95% confidence interval (CI): 0.91 - 0.89) vs. 0.89 (95% CI: 0.90 - 0.88), P = 0.2 vs. 0.82 (95% CI: 0.84 - 0.81), P = 0.001; positive predictive value (PPV) 27% (95% CI: 0.31 - 0.22) vs. 19% (95% CI: 0.22 - 0.16) vs.19% (95% CI: 0.27 - 0.13). CONCLUSIONS: Amount of carotid plaque assessed by carotid plaque imaging significantly improves cardiovascular risk prediction beyond the PROCAM risk equation.
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Adams et al. (2020) conducted a cohort in Healthy subjects without known cardiovascular diseases (n=2,508). Carotid plaque imaging (total plaque area and maximum thickness) vs. PROCAM risk score was evaluated on Prediction of cardiovascular events (Area Under the Curve) (p=0.001). Carotid plaque imaging combining total plaque area and maximum plaque thickness significantly improved the prediction of cardiovascular events compared to the PROCAM risk score (AUC 0.90 vs 0.82, p=0.001).
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